Commonwealth of Kentucky
Organization Active NPI Psychiatry Physician · Louisville, KY
NPI 1598056210 · NPPES record last updated Oct 30, 2024
Key facts
- NPI
- 1598056210
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- COMMONWEALTH OF KENTUCKY
- Practice address
- 10510 Lagrange Road
Louisville, KY 40223 - Phone
- (502) 253-7000
- Fax
- (503) 253-7090
- NPI assigned
- Apr 28, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMONWEALTH OF KENTUCKY
Authorized official
- Name
- Jennifer Moore
- Title
- Assistant Director
- Phone
- (502) 782-6117
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040816000397 | KY | Part B Supplier - Clinic/Group Practice | 9436122710 |
Receives reassigned benefits from 69 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Louisville, KY; Somerset, KY; Lexington, KY; Hopkinsville, KY |
National Provider Directory
- Tax ID family
- West Liberty Elementary
- Part of
- West Liberty Elementary
Locations
401 E Chestnut St
Unit 600
Louisville, KY 40202
Phone (502) 588-4425
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | KY | Yes | |
| Psychiatry Physician |
2084P0800X |
Addresses
Primary practice location
10510 Lagrange Road
Louisville, KY 40223
Mailing address
10510 Lagrange Road
Louisville, KY 40223
Phone (502) 253-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65945396 | Medicaid | KY |
Other names
- Central State Hospital Physicians
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.